The Premera Blue Cross PPO Medical plan offers slightly lower out-of-pocket costs in exchange for higher premiums. With this plan, your costs are more predictable, but you will likely still have out-of-pocket expenses. You can see any provider you wish, but you will pay less when you stay in network.
How the Premera Blue Cross PPO Medical plan works
- Preventive care: You pay nothing for in-network preventive care — it is covered in full
- Deductible: You pay 100% of your medical and prescription costs until you meet the annual deductible.
- Copay or coinsurance: After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority. After meeting the deductible, if applicable, you pay a copay for many services when you use in-network providers. For other services, like hospital stays, or when you use out-of-network providers, you pay a percentage of the cost.
- Out-of-pocket maximum: You are protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Save money with an FSA!
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully. The money in your FSA does not carry over to the next plan year; you must “use it or lose it.”
The maximum Health Care FSA contribution limit is currently $3,200.
Medical Plan Benefits
| Premera Blue Cross PPO Medical | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual deductible (individual/ family) |
$300 / $900 | $400 / $1,2000 |
| Annual out-of-pocket maximum (individual/ family) |
$1,500 / $4,500 | $3,000 / $9,000 |
Your Costs
| Premera Blue Cross PPO Medical | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Preventive care | Covered at 100% no deductible |
Not covered |
| Office visit (primary care) | You pay $20 copay; no deductible | You pay $20 copay, then 40% after deductible |
| Office visit (specialist) | You pay $20 copay; no deductible | You pay $20 copay, then 40% after deductible |
| Telemedicine visit | You pay $20 copay; no deductible | N/A |
| Urgent care | You pay $20 copay; no deductible | You pay $20 copay, then 40% after deductible |
| Emergency room | You pay $300/admission, then 20% after deductible | You pay $400/admission, then 40% after deductible |
| Hospital stay | You pay $300/admission, then 20% after deductible | You pay $400/admission, then 40% after deductible |
| Mental health office visit | You pay $20 copay; no deductible | You pay $20 copay, then 40% after deductible |
| Fertility Testing, Diagnosis and Treatment | You pay 20% after deductible* | You pay 40% after deductible* |
| Physical, Occupational, Speech and Massage Therapy, and Chronic Pain | Inpatient: You pay 20% after deductible (up to 15 days/year) Outpatient: you pay $20 copay; no deductible (up to 45 visits/year |
Inpatient: You pay 40% after deductible (up to 15 days/year) Outpatient: you pay $20 copay; then 40% after deductible (up to 45 visits/year |
| Chiropractor | You pay $20 copay; no deductible | You pay $20 copay, then 40% after deductible |
| Acupuncture | You pay $20 copay; no deductible (up to 12 visits/year) |
You pay $20 copay; then 40% after deductible (up to 12 visits/year) |
*This benefit includes testing, invitro fertilization and artificial insemination. Limit: $2,000 per calendar year; $6,000 lifetime maximum.